Impact of Maternal Education about Complementary Feeding and Provision of Complementary Foods on Child Growth in Developing Countries (Imdad, 2011)
Aamer Imdad, et al., “Impact of Maternal Education about Complementary Feeding and Provision of Complementary Foods on Child Growth in Developing Countries,” supplement, BMC Public Health 11, Suppl. 3:S25 (2011).
URL: www.biomedcentral.com/1471-2458/11/S3/S25/
Abstract
Background: Childhood undernutrition is prevalent in low and middle income countries. It is an important indirect cause of child mortality in these countries. According to an estimate, stunting (height for age Z score < -2) and wasting (weight for height Z score < -2) along with intrauterine growth restriction are responsible for about 2.1 million deaths worldwide in children < 5 years of age. This comprises 21 % of all deaths in this age group worldwide. The incidence of stunting is the highest in the first two years of life especially after six months of life when exclusive breastfeeding alone cannot fulfill the energy needs of a rapidly growing child. Complementary feeding for an infant refers to timely introduction of safe and nutritional foods in addition to breast-feeding (BF) i.e. clean and nutritionally rich additional foods introduced at about six months of infant age. Complementary feeding strategies encompass a wide variety of interventions designed to improve not only the quality and quantity of these foods but also improve the feeding behaviors. In this review, we evaluated the effectiveness of two most commonly applied strategies of complementary feeding i.e. timely provision of appropriate complementary foods (± nutritional counseling) and education to mothers about practices of complementary feeding on growth. Recommendations have been made for input to the Lives Saved Tool (LiST) model by following standardized guidelines developed by Child Health Epidemiology Reference Group (CHERG).
Methods: We conducted a systematic review of published randomized and quasi-randomized trials on PubMed, Cochrane Library and WHO regional databases. The included studies were abstracted and graded according to study design, limitations, intervention details and outcome effects. The primary outcomes were change in weight and height during the study period among children 6-24 months of age. We hypothesized that provision of complementary food and education of mother about complementary food would significantly improve the nutritional status of the children in the intervention group compared to control. Meta-analyses were generated for change in weight and height by two methods. In the first instance, we pooled the results to get weighted mean difference (WMD) which helps to pool studies with different units of measurement and that of different duration. A second meta-analysis was conducted to get a pooled estimate in terms of actual increase in weight (kg) and length (cm) in relation to the intervention, for input into the LiST model.
Imdad et al. conduct a meta-analysis of published research into the impact of maternal health education, specifically the introduction of complementary foods along with breastfeeding, on childhood nutritional status and childhood growth. The authors found that both the introduction of complementary foods and, independently, maternal nutritional education led to “significant increase in weight and height in children 6-24 months of age.” They recommend including these interventions in the Lives Saved Tool (LiST), a tool used by public health leaders and researchers to estimate the costs and benefits of introducing various interventions in developing countries.